Parenting interventions for the prevention of unintentional injuries in childhood: Cochrane systematic review
Assessed as up to date: 2011/01/31
Parent education and training programmes can improve maternal psychosocial health, child behavioural problems, and parenting practices. This review assesses the effects of parenting interventions for reducing child injury.Objectives
To assess the effects of parenting interventions for preventing unintentional injury in children 18 years of age and younger and for increasing possession and use of safety equipment and safety practices by parents.Search methods
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, BIOSIS Preview, PsycINFO, Sociological Abstracts, Social Science Citation Index, CINAHL, ProQuest Dissertations and Theses, ERIC, DARE, ASSIA, Web of Science, SIGLE, and ZETOC. We also handsearched abstracts from the World Conferences on Injury Prevention and Control and from the journal Injury Prevention. The searches were conducted in January 2011.Selection criteria
We included randomised controlled trials (RCTs), non-randomised controlled trials (non-RCTs), and controlled before and after studies (CBAs), which evaluated parenting interventions administered to parents of children 18 years of age and younger and reported outcome data on injuries to children (unintentional or unspecified intent) and possession and use of safety equipment or safety practices (including the Home Observation for Measurement of the Environment (HOME) scale, which contains an assessment of home safety) by parents. Parenting interventions were defined as those with a specified protocol, manual, or curriculum aimed at changing knowledge, attitudes, or skills covering a range of parenting topics.Data collection and analysis
Studies were selected, data were extracted, and quality was appraised independently by two authors. Pooled relative risks (RRs) were estimated using random-effects models.Main results
Twenty-two studies were included in the review: 16 RCTs, two non-RCTs, one partially randomised trial that contained two randomised intervention arms and one non-randomised control arm, two CBA studies, and one quasi-randomised controlled trial. Seventeen studies provided interventions comprising parenting education and other support services, 15 of which were home visiting programmes and two of which were paediatric practice-based interventions. Two provided solely educational interventions. Nineteen studies recruited families who were from socio-economically disadvantaged populations who were at risk of adverse child outcomes or people who may benefit from extra support, such as single mothers, teenage mothers, first-time mothers, and mothers with learning difficulties. Ten RCTs involving 5074 participants were included in the meta-analysis, which indicated that intervention families had a statistically significant lower risk of injury than control families (RR 0.83, 95% confidence interval (CI) 0.73 to 0.94). Sensitivity analyses undertaken that included only RCTs at low risk of various sources of bias found the findings to be robust to including only those studies at low risk of detection bias in terms of blinded outcome assessment and attrition bias in terms of follow-up of fewer than 80% of participants in each arm. When analyses were restricted to studies at low risk of selection bias in terms of inadequate allocation concealment, the effect size was no longer statistically significant. Several studies found statistically significantly fewer home hazards or a greater number of safety practices in intervention families. Of ten studies reporting scores on the HOME scale, data from three RCTs were included in a meta-analysis, which found no evidence of a difference in quality of the home environment between treatment arms (mean difference 0.57, 95% CI -0.59 to 1.72). Most of the studies reporting home safety practices, home hazards, or composite home safety scores found statistically significant effects favouring intervention arm families. Overall, when Grading of Recommendations Assessment, Development, and Evaluation guidelines (GRADE) were used, the quality of the evidence was rated as moderate.Authors' conclusions
Parenting interventions, most commonly provided within the home using multi-faceted interventions, are effective in reducing child injury. Fairly consistent evidence suggests that they also improve home safety. This evidence relates mainly to interventions provided to families from disadvantaged populations, who are at risk of adverse child health outcomes, or whose families may benefit from extra support. Further research is required to explore mechanisms by which these interventions may reduce injury, to identify the features of parenting interventions that are necessary or sufficient to reduce injury, and to assess the generalisability of these findings to different population groups.
Kendrick Denise, Mulvaney Caroline A, Ye Lily, Stevens Tony, Mytton Julie A, Stewart-Brown Sarah
Parenting programmes for the prevention of unintentional injuries in childhood
This review looked at whether parent education and training programmes (called parenting programmes) help parents provide a safer home environment and reduce injuries in children. We undertook the review because several factors that can increase the risk of unintentional injury to children may be helped by parents' attending parenting programmes, such as mothers' mental health and child behaviour problems. In addition, injuries are more likely to occur when parents are unable to predict a child’s ability to perform tasks such as climbing furniture or opening locks. Parenting programmes may help parents develop realistic expectations of their child's behaviour based on age and stage of development. Therefore, we wanted to assess whether parenting programmes reduced the risk of unintentional injuries in children, and whether parents provided a safer home environment by using more items of safety equipment, such as stair gates, and by adopting safe practices such as keeping medicines out of reach.
Through searches of databases and web sites, we found 22 randomised and non-randomised studies that evaluated the effects of parenting programmes on childhood injuries or home safety. Fifteen of these were home visiting programmes that provided a range of support services, as well as parent education or training. These programmes were usually provided to families who were disadvantaged, whose children were considered to be at risk of poor health, or who may benefit from extra support.
We pooled the results from 10 randomised controlled trials, which included a total of 5074 children, and found that children from families who had completed the parenting programmes had sustained fewer injuries than those from families who had not attended the programmes. We pooled the results from three randomized controlled trials that measured home safety using the Home Observation for Measurement of the Environment (HOME) tool. The results from these three studies, which included a total of 368 children, showed no difference in HOME scores between families receiving parenting programmes and those not receiving these programmes. Overall, the quality of the studies was reasonable.
We conclude that parenting programmes are effective in reducing unintentional injury in children and can improve home safety, particularly in families who may be considered 'at risk,' such as some teenage or single mothers. It would be worthwhile for health and social care providers to make parenting programmes available to families.
Implications for practice
Parenting interventions, most commonly provided within the home as part of a multi-faceted intervention to improve a range of child (and often maternal health) outcomes, are effective in reducing self-reported or medically attended unintentional injury. Fairly consistent evidence also suggests that they improve home safety. This evidence relates mainly to interventions provided to families 'at risk' of adverse child health outcomes, including those 'at risk' of child abuse and neglect. Health and social care providers should make home visiting programmes available to such families as part of their injury prevention and wider child and maternal health strategies. Such provision is also likely to have a range of other beneficial effects for maternal and child health.
Implications for research
A series of research questions remain to be answered: whether parenting interventions delivered outside the home have positive effects on childhood injury; whether parenting educational interventions, as opposed to multi-faceted interventions, delivered within or outside the home and aimed at improving a range of parenting practices are effective in reducing childhood injury; whether group-based parenting interventions are effective in reducing childhood injury; whether providing home safety education and safety equipment further increases the effectiveness of parenting interventions in reducing child injury; and finally, whether parenting interventions are effective in reducing child injury when delivered to families not considered to be 'at risk' of adverse child health outcomes.Get full text at The Cochrane Library
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